The Value Plan offers you the opportunity to collect for a flat fee of $16.50 (Phase I). All payments will be paid direct to you in Phase I so it is important to report all payments before the accounts move to Phase II. Please use the Payment Notification Form to report direct payments both in Phase I and Phase II. Social Security number is very important in terms of final recovery; please provide if available.

DEBTOR INFORMATION

Debtor (Brother/Sister) Name

Total Amount Due $

Date of Service

Address (parents if available)

City

State

Zip

Social Security #

Debtor Phone # A/C

Employer Name and Phone (if available)

Brief Description of Debt

CO-SIGNER INFORMATION

Co-signer Name

Co-signer Address

City

State

Zip

Co-signer Phone

Co-signer Social Security # (if available)

Relationship to Primary Debtor

Special Information regarding co-signers: if there is a co-signer, usually the parent/guardian, it is very important to provide this information as the ultimate collection is the responsibility of either the brother/sister or their co-signer. PB staff will attempt collection from both parties so chances of collection are enhanced considerably. If you submit the co-signer information we must have a copy of the signed agreement with your fraternity or sorority (attach to the account assignment form).